Wednesday, December 14, 2011

US Health Care Delivery System Not Fit for Modern Times, Says Berwick

The United States has "set up a [health care] delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable," Donald Berwick, MD, told Kaiser Health News on Monday. "Despite the best efforts of the workforce, we built it wrong. It isn't built for modern times."

Berwick, who stepped down from his post as administrator of the Centers for Medicare and Medicaid Services (CMS) earlier this month, said health reform is changing how physicians and hospitals are paid and care is delivered care through such new arrangements as Accountable Care Organizations (ACOs). But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries.

Berwick said during his tenure at CMS his most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage physicians and hospitals to form ACOs to work more closely, while not making the requirements overly burdensome.

He also criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. "If a patient needs twenty days, the patient should get twenty days," he said.

The best way to provide care is through "managed care done right," Berwick said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need.

Comments

If we go down the road of making health care a right it will create another system built on entitlement that cannot be sustained and will lead to rationing. Berwick is a clever man working for an agenda machine. I pray we don't go there

Posted by Colin
on 12/16/2011 5:59 PM

It is interesting to see the focus on formation of additional levels of management(ACO and MSO)and rules/regulation. The thought that this tri-aim focus of 1.increased accessability, 2.increased levels of care and 3. decreased cost seem be well intentioned but missing reality in my opinion. Reality says adding more rules and additional requirements would add costs and detract from actual provision of care. Academically, I can see that with more communication higher levels of care could be provided. My experience over the past 15 years would say that it isn't the communication but the time necessary to properly diagnose and treat our clients as human beings is what is missing. Decreasing fee schedules has pressured providers to increase volume to maintain the revenue streams required to be succussful in business. I would like to see a fair fee schedule and a standard means of submitting/collecting claims be the focus of reducing cost. This would be patient and provider focused. Letting the patient become informed of who provides the best care (not the one willing to accept their insurance company's contract for the lowest cost possible) would be a means of improving care. This would drive the poor provider out of business as NO ONE WOULD CHOOSE TO GO TO A POOR PROVIDER. If it didnt cost any more and they had access to go to the best(no network requirement), they would chose the best.

Posted by Andrew
on 12/18/2011 7:33 PM

Health is more than a human right, it is a national imperative. You can not have a healthy and productive work force or military with out a healthy population.
Health care is not an option. I spent 30 years in the military including combat in Vietnam. The Military provides health care so that you and your unit are functioning and productive as soon as possible.
Stop worrying about the 5% who abuse any system and worry about the 90% who just want their children and parents to be safe.

Posted by Dave G.
on 12/19/2011 11:54 AM

RE: Comment by Colin:
Health care IS a right, and the USA is the only advanced nation to deny that right to her citizens.
We absolutely need to 'create another system': the system we have fails to provide the full access or quality outcomes other advanced nations have, yet still costs much, much more.
It is our current "privatize the profits, socialize the risks" fractured system of health care plans, including those with no plan, that is so blatantly non-sustainable.
Rationing IS, and HAS BEEN, going on in our health care system for a long time. There's no need to avoid or delay implementing a better health care plan for fear that rationing will appear at some point in the future. It's already here, with severe consequences for the least among us.
The difference between the sort of rationing that's going on now, and the way it would be done in a public, not-for-profit plan will be WHO gets to make the rationing decisions and ON WHAT BASIS the decisions are made. Right now rationing decisions are made by insurance corporations whose entire concern is profit, not by health care practitioners whose primary concern is your health. Insurance corporations are accountable only to shareholders, not to those who need care. Right now rationing is based on economic status, not "evidence based practice". A health care system based on ability to pay is not only morally wrong, but impedes the development of improved, cost-effective, evidence-based health care practices that would benefit all care recipients, no matter the size of their wallet.
The notion that we cannot afford a public, not-for-profit health care plan is ludicrous; other, far less wealthy countries do have universal health plans. The issue isn't whether or not we have the money; it's where our elected officials choose to spend our money.

Posted by Allison
on 12/19/2011 12:13 PM

I figured these comments would come out. To supporters of the health care law passage, ask yourselves these q's. Follow me here with an open mind:
-Who will benefit most from the insurance mandate as the coming health care overhaul dictates?
-Answer: Insurance companies! Ooh, bad corporations. They helped write the bill. Check it out.
-Are welfare systems in place?
-Yes. How much is being paid into this? How many new clinicians will be needed to accomodate 33 million new patients without sacrificing quality? How will the old entitlement system be take into account for the new one?
-The "ability to pay" argument isn't very strong (although some points are valid) as there are many routes available for the under-priveleged to seek care. How do we pay for more and make it a right to do so? The US is 15 trillion dollars in debt already! We would be Greece if we didn't print the world's reserve currency. Who funds the military's health benefits? Who pays taxes to fund the military? BTW, I would bet more than 5% abuse the system (IMO).
-Re: Allison, "The notion that we cannot afford a public, not-for-profit health care plan is ludicrous; other, far less wealthy countries do have universal health plans."
-You're ideologically boxed in. To that statement, ask yourself how Europe is doing right now? I will also reiterate to ask yourself 'who wrote the insurance mandate as dictated in the health care law?' (hmmm, insurance companies maybe?).......If you think its bad now, just wait.
-Name a few countries with our liberties, diversity of patients, and gross population (not Switzerland, Japan, or the NHS in England...please!) that can provide this utopia of patient care based on a right?
--BTW, the old school way to treat is to do it for free via non-profit groups, church organizations, medicaid, or how about a barter system?
-Re: Everyone. Study Berwick's history. If you have done any research at all, you wouldn't trust him to run our system. I agree there are great changes to be made. I'm not writing this to propose 'epic' changes of my own. I am simply pointing out that the proposed changes coming down the pipe aren't in our best interests. People need to question this and think out of our ideological boxes.
Truly, all the best. I pray for our futures, not only as practitioners but Americans' mind, body, and spirits as a whole.